Protocol for a randomized controlled trial examining multilevel prediction of response to behavioral activation and exposure-based therapy for generalized anxiety disorder.

BACKGROUND: Only 40-60% of patients with generalized anxiety disorder experience long-lasting improvement with gold standard psychosocial interventions. Identifying neurobehavioral factors that predict treatment success might provide specific targets for more individualized interventions, fostering more optimal outcomes and bringing us closer to the goal of "personalized medicine." Research suggests that reward and threat processing (approach/avoidance behavior) and cognitive control may be important for understanding anxiety and comorbid depressive disorders and may have relevance to treatment outcomes. This study was designed to determine whether approach-avoidance behaviors and associated neural responses moderate treatment response to exposure-based versus behavioral activation therapy for generalized anxiety disorder. METHODS/DESIGN: We are conducting a randomized controlled trial involving two 10-week group-based interventions: exposure-based therapy or behavioral activation therapy. These interventions focus on specific and unique aspects of threat and reward processing, respectively. Prior to and after treatment, participants are interviewed and undergo behavioral, biomarker, and neuroimaging assessments, with a focus on approach and avoidance processing and decision-making. Primary analyses will use mixed models to examine whether hypothesized approach, avoidance, and conflict arbitration behaviors and associated neural responses at baseline moderate symptom change with treatment, as assessed using the Generalized Anxiety Disorder-7 item scale. Exploratory analyses will examine additional potential treatment moderators and use data reduction and machine learning methods. DISCUSSION: This protocol provides a framework for how studies may be designed to move the field toward neuroscience-informed and personalized psychosocial treatments. The results of this trial will have implications for approach-avoidance processing in generalized anxiety disorder, relationships between levels of analysis (i.e., behavioral, neural), and predictors of behavioral therapy outcome. TRIAL REGISTRATION: The study was retrospectively registered within 21 days of first participant enrollment in accordance with FDAAA 801 with ClinicalTrials.gov, NCT02807480. Registered on June 21, 2016, before results.

Functional neuroimaging of sex differences in autobiographical memory recall in depression.

BACKGROUND: Females are more likely than males to develop major depressive disorder (MDD). The current study used fMRI to compare the neural correlates of autobiographical memory (AM) recall between males and females diagnosed with MDD. AM overgenerality is a persistent cognitive deficit in MDD, the magnitude of which is correlated with depressive severity only in females. Delineating the neurobiological correlates of this deficit may elucidate the nature of sex-differences in the diathesis for developing MDD. METHODS: Participants included unmedicated males and females diagnosed with MDD (n = 20/group), and an age and sex matched healthy control group. AM recall in response to positive, negative, and neutral cue words was compared with a semantic memory task. RESULTS: The behavioral properties of AMs did not differ between MDD males and females. In contrast, main effects of sex on cerebral hemodynamic activity were observed in left dorsolateral prefrontal cortex and parahippocampal gyrus during recall of positive specific memories, and middle prefrontal cortex (mPFC), and precuneus during recall of negative specific memories. Moreover, main effects of diagnosis on regional hemodynamic activity were observed in left ventrolateral prefrontal cortex and mPFC during positive specific memory recall, and dorsal anterior cingulate cortex during negative specific memory recall. Sex × diagnosis interactions were evident in the dorsomedial prefrontal cortex, caudate, and precuneus during positive memory recall, and in the posterior cingulate cortex, insula, precuneus and thalamus during negative specific memory recall. CONCLUSIONS: The differential hemodynamic changes conceivably may reflect sex-specific cognitive strategies during recall of AMs irrespective of the phenomenological properties of those memories.

Increased anterior insula activity in anxious individuals is linked to diminished perceived control.

Individuals with high-trait anxiety frequently report decreased perceived control. However, it is unclear how these processes are instantiated at a neural level. Prior research suggests that individuals prone to anxiety may have exaggerated activity in the anterior insula and altered activity in the cingulate cortex during anticipation of aversive events. Thus, we hypothesized that anxiety proneness influences anterior insula activation during anticipation of unpredictable threat through decreased perceived control. Forty physically healthy adults underwent neuroimaging while they explored computer-simulated contexts associated either with or without the threat of an unpredictable shock. Skin conductance, anxiety ratings and blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging were used to assess responses to threat versus no threat. Perceived control was measured using the Anxiety Control Questionnaire-Revised. Mediation analysis examined how anxiety proneness influenced BOLD activity. Anticipation of unpredictable threat resulted in increased skin conductance responses, anxiety ratings and enhanced activation in bilateral insula, anterior midcingulate cortex (aMCC) and bed nucleus of the stria terminalis. Individuals with greater anxiety proneness and less perceived control showed greater activity in dorsal anterior insula (dAI). Perceived control mediated the relationship between anxiety proneness and dAI activity. Increased dAI activity was associated with increased activity in aMCC, which correlated with increased exploratory behavior. Results provide evidence that exaggerated insula activation during the threat of unpredictable shock is directly related to low perceived control in anxiety-prone individuals. Perceived control thus may constitute an important treatment target to modulate insula activity during anxious anticipation in anxiety-disordered individuals.

Neurophysiological correlates of autobiographical memory deficits in currently and formerly depressed subjects.

BACKGROUND: Individuals with major depressive disorder (MDD) tested in either the depressed (dMDD) or remitted phase (rMDD) recall fewer specific and more categorical autobiographical memories (AMs) compared to healthy controls (HCs). The current study aimed to replicate findings of AM overgenerality in dMDD or rMDD, and to elucidate differences in neurophysiological correlates of AM recall between these MDD samples and HCs. METHOD: Unmedicated participants who met criteria for the dMDD, rMDD or HC groups (n = 16/group) underwent functional magnetic resonance imaging (fMRI) while recalling AMs in response to emotionally valenced cue words. Control tasks involved generating examples from an assigned semantic category and counting the number of risers in a letter string. RESULTS: The results showed fewer specific and more categorical AMs in both MDD samples versus HCs; dMDDs and rMDDs performed similarly on these measures. The neuroimaging results showed differences between groups in the dorsomedial prefrontal cortex (DMPFC), lateral orbitofrontal cortex (OFC), anterior insula, inferior temporal gyrus and parahippocampus/hippocampus during specific AM recall versus example generation. During specific AM recall cued by positively valenced words, group differences were evident in the DMPFC, middle temporal gyrus, parahippocampus/hippocampus and occipital gyrus, whereas differences during specific AM recall cued by negatively valenced words were evident in the DMPFC, superior temporal gyrus and hippocampus. CONCLUSIONS: AM deficits exist in rMDDs, suggesting that these impairments constitute trait-like abnormalities in MDD. We also found distinct patterns of hemodynamic activity for each group as they recalled specific AMs, raising the possibility that each group used a partly unique strategy for self-referential focus during successful retrieval of specific memories.

Physiological noise effects on the flip angle selection in BOLD fMRI.

This work addresses the choice of imaging flip angle in blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI). When noise of physiological origin becomes the dominant noise source in fMRI timeseries, it causes a nonlinear dependence of the temporal signal-to-noise ratio (TSNR) versus signal-to-noise ratio (SNR) that can be exploited to perform BOLD fMRI at angles well below the Ernst angle without any detrimental effect on our ability to detect sites of neuronal activation. We show, both experimentally and theoretically, that for situations where available SNR is high and physiological noise dominates over system/thermal noise, although TSNR still reaches it maximum for the Ernst angle, reduction of imaging flip angle well below this angle results in negligible loss in TSNR. Moreover, we provide a way to compute a suggested imaging flip angle, which constitutes a conservative estimate of the minimum flip angle that can be used under given experimental SNR and physiological noise levels. For our experimental conditions, this suggested angle equals 7.63° for the grey matter compartment, while the Ernst angle=77°. Finally, using data from eight subjects with a combined visual-motor task we show that imaging at angles as low as 9° introduces no significant differences in observed hemodynamic response time-course, contrast-to-noise ratio, voxel-wise effect size or statistical maps of activation as compared to imaging at 75° (an angle close to the Ernst angle). These results suggest that using low flip angles in BOLD fMRI experimentation to obtain benefits such as (1) reduction of RF power, (2) limitation of apparent T(1)-related inflow effects, (3) reduction of through-plane motion artifacts, (4) lower levels of physiological noise, and (5) improved tissue contrast is feasible when physiological noise dominates and SNR is high.

Mapping the MRI voxel volume in which thermal noise matches physiological noise--implications for fMRI.

This work addresses the choice of the imaging voxel volume in blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI). Noise of physiological origin that is present in the voxel time course is a prohibitive factor in the detection of small activation-induced BOLD signal changes. If the physiological noise contribution dominates over the temporal fluctuation contribution in the imaging voxel, further increases in the voxel signal-to-noise ratio (SNR) will have diminished corresponding increases in temporal signal-to-noise (TSNR), resulting in reduced corresponding increases in the ability to detect activation induced signal changes. On the other hand, if the thermal and system noise dominate (suggesting a relatively low SNR) further decreases in SNR can prohibit detection of activation-induced signal changes. Here we have proposed and called the "suggested" voxel volume for fMRI the volume where thermal plus system-related and physiological noise variances are equal. Based on this condition we have created maps of fMRI suggested voxel volume from our experimental data at 3T, since this value will spatially vary depending on the contribution of physiologic noise in each voxel. Based on our fast EPI segmentation technique we have found that for gray matter (GM), white matter (WM), and cerebral spinal fluid (CSF) brain compartments the mean suggested cubical voxel volume is: (1.8 mm)3, (2.1 mm)3 and (1.4 mm)3, respectively. Serendipitously, (1.8 mm)3 cubical voxel volume for GM approximately matches the cortical thickness, thus optimizing BOLD contrast by minimizing partial volume averaging. The introduced suggested fMRI voxel volume can be a useful parameter for choice of imaging volume for functional studies.

B(0)-fluctuation-induced temporal variation in EPI image series due to the disturbance of steady-state free precession.

Steady-state free precession (SSFP) can develop under a train of RF pulses, given the condition TR < T(2). SSFP in multi-shot imaging sequences has been well studied. It is shown here that serial single-shot echo-planar imaging (EPI) acquisition can also develop SSFP, and the SSFP can be disturbed by B(0) fluctuation, causing voxel-wise temporal variation. This SSFP disturbance is predominantly present in cerebrospinal fluid (CSF) regions due to the long T(2) value. By applying a sufficiently strong crusher gradient in the EPI pulse sequence, the temporal variation induced by SSFP disturbance can be suppressed due to diffusion. Evidence is provided to indicate that physiological motions such as cardiac pulsation and respiration could affect the voxel-wise time courses through the mechanism of SSFP disturbance. It is advised that if the disturbance is observed in serial EPI images, the crusher should be made stronger to eliminate the unwanted temporal variation.

Heroin-induced neuronal activation in rat brain assessed by functional MRI.

The present study demonstrates the application of fMRI technology to neuropharmacology and the interaction of drug/receptor in the rat brain. Specifically, we have observed two different types of fMRI signal changes induced by acute i.v. heroin administration in rat brains under conditions of spontaneous and artificial respiration. Under spontaneous respiration, a global decrease in fMRI signal was observed; under artificial respiration, a region-specific increase in fMRI signal was identified and the activation sites are consistent with the distribution of opiate mu-receptors in rat brain as previously reported by autoradiography. Both heroin-induced fMRI signal changes were suppressed by pretreatment of naloxone, an opiate mu-receptor antagonist, and reversed by injection of naloxone following heroin infusion. These results suggest that fMRI has specific advantages in spatial and temporal resolution for studies of neuropharmacology and drugs of abuse.

Current-induced magnetic resonance phase imaging.

Electric current-induced phase alternations have been imaged by fast magnetic resonance image (MRI) technology. We measured the magnetic resonance phase images induced by pulsed current stimulation from a phantom and detected its sensitivity. The pulsed current-induced phase image demonstrated the feasibility to detect phase changes of the proton magnetic resonance signal that could mimic neuronal firing. At the present experimental setting, a magnetic field strength change of 1.7 +/- 0.3 nT can be detected. We also calculated the averaged value of the magnetic flux density BT parallel to B0 produced by electric current I inside the voxel as a function of the wire position. The results of the calculation were consistent with our observation that for the same experimental setting the current-induced phase change could vary with location of the wire inside the voxel. We discuss our findings in terms of possible direct MRI detection of neuronal activity.

A comparison of febrile responses induced by LPS from E. coli and S. abortus in unrestrained rats placed in a thermal gradient.

The purpose of our study was a comparison of pyrogenic and behavioural effects of Escherichia coli (E.coli) and Salmonella abortus (S.abortus) endotoxins in unrestrained, freely moving Wistar rats, placed in a thermal gradient and having an easy access to ambient temperatures within a range 5-40 degrees C. Hypothalamic and chosen by the rats ambient temperatures as well as locomotor activity were recorded before and after intraperitoneal injection of 1 mg/kg lipopolysaccharide from E. coli or from S. abortus. Control animals were injected with pyrogen-free saline. Both endotoxins induced warm-seeking behaviour which was accompanied by biphasic fever. Locomotor activity of LPS-injected rats was reduced. S. abortus-induced fever peaked at 100th minute (reaching 37.5 +/- 0.2 degrees C) and at 250th minute (reaching 38.1 +/- 0.1 degrees C). Respective data for E. coli fever were: 170th minute (when hypothalamic temperature reached 37.6 +/- 0.3 degrees C) and 430th minute (with hypothalamic temperature of 38.6 +/- 0.1 degrees C). Comparing to S. abortus-generated fever both peaks of E. coli LPS-induced fever were significantly delayed (p < 0.05). A limited structural variability of lipid A from both bacteria is likely to be responsible for the difference in fever timing recorded in this study.

Evidence of surface diffusion of water molecules on proteins of rabbit lens by 1H NMR relaxation measurements.

In this work, we propose a relaxation model for the interpretation of NMR proton spinlattice and spin-spin relaxation times of mammalian lenses. The framework for this model is based on nuclear magnetic spin-lattice relaxation measurements as a function of temperature at different Larmor frequencies for whole rabbit lenses and fragments of the lens. According to this model, two different dynamic processes of the water molecules determine the relaxation behaviour, namely rotational diffusion and translational surface diffusion. These dynamic processes in conjunction with a two site exchange model give a good explanation of all the measured relaxation data. From the experimental data, we were able to obtain the activation parameters for rotational and translational diffusion of bound lens water. Correlation times of 2.1 x 10(-11) sec and 2.5 x 10(-9) sec and activation energies of 20.5 kJ/mol and 22.5 kJ/mol respectively were found at 308K. At low Larmor frequencies (< or = 100 MHz) the longitudinal relaxation is mainly determined by translational surface diffusion of bound water with a mean square displacement of 1.5 nm, whereas at higher frequencies (> or = 300 MHz), rotational diffusion is the main relaxation mechanism. The spin-spin relaxation is determined by translational diffusion over the whole frequency range and therefore shows only a very small dispersion. By our model it is possible to explain: 1) the strikingly large difference between the T1 value and the T2A and T2B values observed in the lens and 2) the different values of the activation energies measured at different fields for the lens.

1H NMR and calorimetric measurements on rabbit eye lenses.

The dynamic properties of water molecules in the rabbit lens were studied by proton nuclear magnetic resonance line shape analysis, measurements of relaxation times as a function of temperature and calorimetric measurements. The experiments prove, as already suggested by other authors, that there are two types of water in the lens of rabbit eyes, namely bound unfreezable hydration water and bulk freezable water. Line shape analysis and relaxometry showed, that this two types of water exist in two different environments, which may be identified as the nucleus and the cortex of the lens. The line shape analysis showed furthermore that water molecules in the rabbit lens has a common spin lattice relaxation time (T1), but two different transverse relaxation times (T2A and T2B). The tentative model of fast water exchange on the T1 time scale and slow water exchange on the T2 time scale, was used to explain experimental proton relaxation data of the rabbit lens. An estimation for this exchange rate kex by comparing it to the relaxation times is given (T1(-1) << kex << T1(-1)). It has also been shown by a calorimetric measurements, that the lenses can be easily under-cooled to temperatures well below the freezing point of water. The achievable maximum undercooling temperature of the lens is a function of the cooling rate KC, therefore it has to be considered as an experimentally adjustable parameter which is not characteristic for the investigated sample. Thus it must be noted that any previous discussions about the specific value of the temperature of water crystallisation in biological systems need to be carefully reconsidered.

Measurements of proton relaxation time T2 on cattle eyes lenses.

A simple two phase model does not explain the temperature dependence of T1 relaxation time in lenses as biological systems. Therefore, a distribution of correlation times of water particles has to be assumed by a certain distribution of the water protein binding energy. As a consequence, from the temperature dependence of T1 relaxation time, the activation energy of water molecules in the lens cannot be evaluated directly without the knowledge of the distribution width. This problem can be solved by T2 measurements in lenses. From the slope of T2 as a function of temperature, mean activation energy can be calculated independently on the distribution width. Measurements were performed on lenses originating from 5-7 years old cows, 2-year old bull-calfs and a 12-year old bull in the temperature range -30 to +105 degrees C. It could be demonstrated that about 80% of water behaves as liquid-like water with an activation energy 14 +/- 4 kJ/mol corresponding to the value of free water. The remaining water (about 20%) is bound to the protein with an activation energy of 20 +/- 5 kJ/mol. At 42 degrees C the protein denaturation process starts in the eye lens and will be completed by 70 degrees C, yielding a protein bound-water complex.